On Getting More Bang for the Buck

As I have highlighted in previous posts of this blog, there’s a lot of data showing a deterioration in a number of major social indicators over the last forty years, despite massive increases in public spending and a huge proliferation of not-for-profit organizations. Overall, the dominant approaches that have been taken during the past several decades have not reduced a lot of our social problems. One could even argue that some of those approaches have actually made matters worse.

Fortunately, there are some steps being taken that might eventually result in more effective use of public and philanthropic dollars to alleviate social problems. According to the Coalition for Evidence-based Policy,” the Office of Management and Budget (OMB) has launched a major new push for the development and use of rigorous evidence in budget, management and policy decisions across the federal government…”

The kind of rigorous evidence to which OMB is referring is the kind that Nurse-Family Partnership (NFP) has been able to demonstrate over a long period of time. NFP is, to use language of the Coalition for Evidence-based Policy, an intervention “shown in well-conducted randomized controlled trials… to produce sizeable, sustained benefits to participants and/or society.”

NFP is a nurse-led home visitation program for first-time moms in low income households who voluntarily enroll no later than the 28th week of pregnancy. A registered nurse makes frequent home visits to help improve pregnancy outcomes, help parents learn how to provide responsible and competent care for their children, and help improve the economic self-sufficiency of the family. Regular visits by the nurse continue until the children are two years old.

Goodwill worked for three years to bring NFP to Indiana, and we have begun implementing the program in Indianapolis. At capacity, our registered nurses will be working with 600 moms at a time.

Thirty years of randomized controlled trials have produced evidence of the incredible long term benefits of NFP. For example:

    48% reduction in child abuse and neglect through child age 15
    56% fewer doctor and hospital visits due to childhood injuries through child age 2
    67% fewer behavioral and intellectual problems in children at age 6
    69% fewer convictions of nurse-visited children at age 15
    72% fewer convictions of mothers when children are at age 15
    83% increase in workforce participation by low-income, unmarried mothers by the time their child is four years old

The Rand Corporation calculated that every dollar invested in NFP results in a $5.70 return to society.

Some people don’t want to invest public dollars in programs such as these because, they emphasize, parents are responsible for giving their child a strong, healthy start. I agree that it’s the parent’s responsibility. However, when a parent is unable–for whatever reason–to exercise that responsibility well, the rest of us have a choice. We can invest up front to help prevent problems and develop human potential – or we can do as we’re now doing and continue to pay much more downstream for public assistance, remedial education, rehabilitation, incarceration, and in all the insidious ways we all pay when we have a poorly educated, under-skilled workforce.

It’s also important to remember that no child has any choice about the circumstances into which he or she is born.

If we really want more bang for our buck, we will begin shifting support from programs with marginal return to those that can demonstrate high, long-term benefits. Doing so will upset some people, but will result in a wiser, more effective use of the dollars that are available. The potential long-term benefits are enormous.

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